This invention relates to video endoscopy and to endosurgery, wherein endoscopy is understood to refer to all forms of medical endoscopy, including but not limited to laparoscopy, thoracoscopy, arthroscopy, gastroscopy, hysteroscopy, colonoscopy, and bronchoscopy, as well as to dental applications of endoscopy and to the use of endoscopic inspection instruments, such as borescopes, for nonmedical applications, wherein video endoscopy refers to endoscopic visualization utilizing video acquisition and display of endoscopic images and wherein endosurgery refers to all surgical procedures performed under endoscopic visualization, including but not limited to tissue and organ repair, resection, implantation, and biopsy.
More specifically, this invention is related to a method and apparatus for improving manual dexterity in endoscopy and endosurgery by combining endoscopic, manipulative, video image forming, and video image display means in a novel manner that provides the surgeon or operator with improved hand-eye coordination.
The advantages of diagnosis and therapy performed under endoscopic visualization are well known. Such procedures are minimally invasive, result in shortened hospital stays, more rapid recovery, less cosmetic damage, and lower overall costs compared to conventional "open" procedures. However, most surgeons have much greater difficulty performing common surgical maneuvers using endosurgical instruments (long-shafted graspers, scissors, etc. commonly used in endoscopic surgery) under endoscopic visualization. Whether the image is viewed by the surgeon with his eye to the eyepiece or, as is increasingly common, on a video monitor, the surgeon has poor hand-eye coordination compared to that of open surgery. The surgeon moves the instruments hesitantly and often inaccurately, whereas in open surgery the motion is rapid and precise. Simple routines, such as suturing and knot tying, are tedious and time consuming, even for highly skilled endoscopic surgeons. As a result, endoscopic procedures generally take more operating-room time than their open counterparts and are more exhausting for the surgeon. Moreover, many capable surgeons can not adequately master endoscopic technique; consequently, surgeries that potentially could be done endoscopically are still being performed as open procedures. In laparoscopic surgery, surgeons that operate with an instrument in each hand require the assistance of another surgeon to hold and direct the laparoscope, which increases the cost of the procedure. There is a need for new endoscopic surgery instruments and methods to overcome these limitations. The present invention addresses this need. It improves on prior-art endoscopic methods by providing the surgeon with greater hand-eye coordination by making endoscopic surgery look and feel more like open surgery.
In the discourse that follows, reference is made to "enhanced presence", which is defined below in connection with a special arrangement of a video endoscope, image display, and endosurgical instrument whereby the image of the distal tip of the endosurgical instrument is presented on a video display adjacent to the instrument handle and in a specific manner, along with the bodily tissues near the tip. The intent is to induce the surgeon to act as if the image of the tip, as seen in the display, is the tip itself. The reader will understand that the surgeon will not be actually deceived in this regard, but will, nevertheless, find it natural to respond as if he were. The surgeon will thus be led to instinctively use hand motions that are effective to accomplish endosurgical tasks, whereas with conventional endosurgical apparatus these motions are difficult to learn.